Less Invasive Tx Touted in Older NSCLC Patients

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This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Video-assisted thoracoscopic resection may be a good surgical option for non-small cell lung cancer (NSCLC) treatment in elderly patients.

Note that serious complications were less common with the minimally-invasive surgery compared with the open approach.

ATLANTA -- Video-assisted thoracoscopic resection may be a good surgical option for treatment of non-small cell lung cancer (NSCLC) in elderly patients, a case series study suggested.

The procedure was associated with shorter hospitalizations compared with conventional thoracotomy among patients in their 80s, Chad Hall, BS, of the University of Nebraska in Omaha, and colleagues found.

Serious complications were less common with the minimally-invasive surgical approach as well, the group reported at the annual CHEST meeting here.

"More octogenarians should be considered for surgical management of NSCLC," they stated in the poster presentation.

However, this "disease of the elderly" often is treated with chemotherapy or palliative care because many patients over 80 are not considered surgical candidates based on age and underlying co-morbidities, the group explained.

To show the feasibility of surgical resection for NSCLC in this older group, Hall and colleagues reported the experience at their institution by surgically treating 40 NSCLC patients, ages 80 to 90, since 2002.

Half were done as video-assisted thoracoscopic surgeries, the rest were open thoracotomies. The mean patient age was 83, without a difference between the two treatment groups.

Retrospective chart review indicated a range of procedures across the cohort:

17 right upper lobectomies

Five left upper lobectomies

One right middle lobectomy

One right lower lobectomy with superior segmentectomy

Eight right lower lobectomies

Eight left lower lobectomies

Overall, 80% of patients had some complication from NSCLC resection.

Four patients died during open surgery, compared with one undergoing a minimally-invasive resection.

Other serious complications, while infrequent, included acute respiratory distress syndrome and cerebrovascular accident. Less severe complications included atrial fibrillation, prolonged air leaks, urinary retention, and pneumonia.

One notable difference between open and minimally-invasive procedures was the average duration of the hospital stay afterward, which was 7.3 days for the video-assisted thoracoscopic resections compared with 11.6 for the conventional thoracotomies (P=0.05).

"Post-operative length of stay is highly variable and dependent on the type of operation and post-operative complications," the researchers acknowledged.

Nevertheless, they concluded that the operative complications and length of stay findings seen in the study support a benefit of video-assisted thoracoscopic resection over open thoracotomy for NSCLC in elderly patients in their 80s.

Limitations of the study included the relatively small sample size, single-center design, and the lack of a nonsurgical comparison group.

The researchers reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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